Surgeon-Journal of the Royal Colleges of Surgeons of Edinburgh and Ireland最新文献

Background

The current bleep communication system between nurses and interns on-call in most Irish hospitals has been linked with interruption in patient care, disruption to workflow, inefficiency, increased burden and stress to the on-call health staff. A new electronic system was introduced in a University Hospital to replace and eliminate bleep usage during on-call hours.

Methods

An Intern on-call task electronic template was generated using Microsoft Excel Spreadsheet. This electronic system enabled users to review and respond to requests placed by nursing healthcare staff. This project initially underwent a trial process in three wards for a period of two weeks in June 2023. Interns and nurses were asked to fill a survey before and after introduction of the system. The project was implemented across all wards in August 2023 and a secondary survey was obtained. In addition, the spreadsheets were analysed retrospectively.

Results

During the trial, twenty-six interns and twenty nurses were surveyed before and after implementation of the electronic system. Interns satisfaction rate was 73% and stress was reported to be reduced by 65%. Notably, 57% of interns reported a reduction in workload and the number of bleeps was reported to be as <10 by 42%. Nurses reported a decrease in the number of bleeps they needed to send overall by 65% and by 55% for repeated jobs. Workload was reported to be increased by 15% by nurses. However, exactly half of the nurses were unhappy with the new system and stress levels were unchanged.

Conclusion

This project has shown promising results, efficient and clear communication was noted with an overall positive feedback and satisfaction rate by doctors. However, as evident, from a nursing perspective further work is needed to further progress into a system that can benefit both parties involved.

Introduction

Methods

Results

Conclusion

Level of evidence

Background

The Intercollegiate Membership of the Royal College of Surgeons (MRCS) examination is a mandatory requirement for higher specialty surgical training in the UK. However, there is a significant economic impact on trainees which raises the question of whether the costs of this exam hinder surgical career progression. This study explores the burden of these exams on trainees.

Methods

A 37-point questionnaire was distributed to all trainees who were preparing for or have sat MRCS examinations. Univariate analyses included the cost of the preparatory resources, extra hours worked to pay for these and the examinations, and the number of annual leave (AL) days taken to prepare. Pearson correlation coefficients were used to identify possible correlation between monetary expenditure and success rate.

Results

On average, trainees (n ​= ​145) spent £332.54, worked 31.2 ​h in addition to their rostered hours, and used 5.8 AL days to prepare for MRCS Part A. For MRCS Part B/ENT, trainees spent on average £682.92, worked 41.7 extra hours, and used 5 AL days. Overall, the average trainee spent 5–9% of their salary and one-fifth of their AL allowance to prepare for the exams. There was a positive correlation between number of attempts and monetary expenditure on Part A preparation (r(109)=0.536, p ​< ​0.001).

Conclusions

There is a considerable financial and social toll of the MRCS examination on trainees. Reducing this is crucial to tackle workforce challenges that include trainee retention and burnout. Further studies exploring study habits can help reform study budget policies to ease this pressure on trainees.

Introduction

Thyroidectomy is a common surgical procedure. Traditional options for pain management, such as analgesics and nonsteroidal anti-inflammatory medications (NSAIDs), are limited by their side effects. Surgical wound infiltration with local anesthetics has the potential to reduce the need for analgesics in a number of surgical procedures. This systematic review and meta-analysis wanted to resolve these concerns and assess the efficacy of WI in the management of postoperative pain after thyroidectomy.

Material and methods

The review adhered to Cochrane Collaboration and PRISMA standards. RCTs comparing WI with no infiltration or placebo were included. Patients with benign or malignant thyroid disease who underwent open thyroidectomy were eligible. Postoperative pain was assessed using a visual analogue scale (VAS) as the primary outcome. Time to first rescue dose, the need for analgesic rescue in the first 24 h, and total opioid analgesic consumption were secondary outcomes. Standardized mean difference (SMD) and odds ratio (OR) were used to analyze the data.

Results

16 randomized controlled trials involving 1202 patients were included. At 6 and 8 h postoperatively, WI exhibited a statistically significant impact on pain management. In the WI group, the need for analgesic rescue was significantly reduced. At 4 h postoperatively, non-anesthetic medications demonstrated a significant analgesic effect.

Conclusions

This systematic review and meta-analysis support the use of WI with local anesthetics for postoperative pain management after thyroidectomy. These findings have significant implications for improving perioperative care, especially in ambulatory settings where effective pain management is essential.

Background

This study evaluates the clinical outcomes of contemporary total ankle arthroplasty (TAAs) to primarily establish the current benefits and risks to facilitate informed decision making to secondarily establish if improvements are seen between subsequent generations of implants, bearing philosophy, and associated surgical technique.

Methods

A systematic review and meta-analysis of published data from January 2000 to January 2020 was conducted following PRISMA guidelines. Inclusion criteria: English language papers, adult population, ≥20 ankles with a minimum follow up ≥24 months, pre- and post-operative functional scores available. Ankle implants were characterised by generations, which were determined from the original studies and confirmed based on literature set definitions.

Results

A total of 4642 TAAs in 4487 patients from 51 studies were included. The mean age was 61.9-years and follow up 57.8-months. Overall, 10-year survivorship rates were 77.63 %, with mobile bearing designs showing a small but significant advantage. Improved survivorship favoured the most modern implants at both two (p < 0.05), and 10-years (p < 0.01).

The relative risk of a complication occurring improved with the evolution of implants e.g., nerve injury, and post-operative complications such as fracture, wound complications (e.g., dehiscence or heamatoma) and radiological abnormalities (e.g., radiolucencies, heterotopic bone formation and aseptic loosening). However, surgical site infection, and intra-operative fracture rates remain implant independent.

Conclusions

Modern TAA offers improved survivorship, even with a trend to lower mean implantation age, similar complexity and ever changing indications. It would appear that implant evolution has reduced risks, especially those associated with revision, without affecting functional outcomes.

Introduction

Kidney transplantation is the treatment of choice for patients with end stage renal disease. The primary aim of this study was to assess the demographics of deceased kidney donors over the last ten years and to assess for gender variations in deceased donor demographics over an extended period.

Methods

A retrospective data analysis was carried out using data from the national renal transplant database. All deceased donors who donated a kidney between 1st January 2012 and 31st December 2021 were included. Data points extracted included gender, age, cause of death and month of death. Descriptive analyses were carried out using Excel v16.67.

Results

A total of 1219 kidneys from 650 donors were donated over the ten-year period. The mean donor age was 44.01 years (range 1–74 years). The most common cause of death overall was subarachnoid haemorrhage (SAH), which was the cause of death in 27.8 % of donors (n = 180). Male donors accounted for 57.8 % of donors overall (n = 376). Variation in causes of death was observed between male and female donors, and between younger and older donors. 9 % of male deaths were from suicide compared with 5 % of female deaths. 6 % of male deaths were due to a traumatic head injury, with this accounting for 2 % of female deaths. Deaths due to assault made up 2 % of male donor deaths, but were not a cause of death for any female donors.

Conclusion

SAH and intracranial bleeds were the most common cause of death in both groups for deceased donor renal transplantation. Incidence of suicide as cause of death in deceased donors is rising in males.

Purpose

The use of artificial intelligence (AI) tools to aid in summarizing information in medicine and research has recently garnered a huge amount of interest. While tools such as ChatGPT produce convincing and naturally sounding output, the answers are sometimes incorrect. Some of these drawbacks, it is hoped, can be avoided by using programmes trained for a more specific scope. In this study we compared the performance of a new AI tool (the-literature.com) to the latest version OpenAI's ChatGPT (GPT-4) in summarizing topics that the authors have significantly contributed to.

Methods

The AI tools were asked to produce a literature review on 7 topics. These were selected based on the research topics that the authors were intimately familiar with and have contributed to through their own publications. The output produced by the AI tools were graded on a 1–5 Likert scale for accuracy, comprehensiveness, and relevance by two fellowship trained consultant radiologists.

Results

The-literature.com produced 3 excellent summaries, 3 very poor summaries not relevant to the prompt, and one summary, which was relevant but did not include all relevant papers. All of the summaries produced by GPT-4 were relevant, but fewer relevant papers were identified. The average Likert rating was for the-literature was 2.88 and 3.86 for GPT-4. There was good agreement between the ratings of both radiologists (ICC = 0.883).

Conclusion

Summaries produced by AI in its current state require careful human validation. GPT-4 on average provides higher quality summaries. Neither tool can reliably identify all relevant publications.